Sunday, September 07, 2014

After all, we are real doctors now.

Pranay Sinha zeroes in on some important physician training and developmental issues in an op-ed in last week's New York Times.  Some excerpts, with my emphases:

Interns are often bewildered at how rapidly things change for us from May to July. As medical students, while we felt compelled to work hard and excel, our shortfalls were met with reassurances: “It will all come in time.” But as soon as that M.D. is appended to our names in May, our self-expectations skyrocket, as if the conferral of the degree were an enchantment of infallibility. The internal pressure to excel is tremendous: After all, we are real doctors now.
In fact, very little about us changes, apart from our legal ability to prescribe medications. But meanwhile, our workload increases along with the expectations and demands we place on ourselves.

This drastic increase in responsibility can and does overwhelm most interns. Despite the support of my supervisors, my first two months were marked by severe fatigue, numerous clinical errors (that were promptly caught by my supervisors), a constant and haunting fear of hurting my patients and an inescapable sense of inadequacy.

We need to be able to voice these doubts and fears. We need to be able to talk about the sadness of that first death certificate we signed, the mortification at the first incorrect prescription we ordered, the embarrassment of not knowing an answer on rounds that a medical student knew. A medical culture that encourages us to share these vulnerabilities could help us realize that we are not alone and find comfort and increased connection with our peers. It could also make it easier for residents who are at risk to ask for help. And I believe it would make us all better doctors.

Compare this to the approach at our Telluride summer sessions, where we spend many hours helping medical students and residents deal with their fallibility--with an emphasis on better communication among clinicians and with patients and families, especially when errors or near-misses occur.  For most residents, this is more time that they have cumulatively spent on such topics than in all their years of medical school and post-graduate training.  Here's recent note from one of our alumni:

Just wanted to share a thank you letter that I received from a patient. I would like to emphasize that I took a lot away from Telluride and came in to internship headstrong to live up to the ideals presented. 

Here's are excerpts from the patient's letter:

From the very first time you came into Mom's room, and introduced yourself, your warmth and open manner immediately made us both feel comfortable and relaxed.  You took the time out of your busy day to sit and talk to me about Mom made me feel like she mattered to you as a person, not just the patient in room 458.

I personally appreciated your telling me to continue to advocate on behalf of my Mom.  You made it ok for me to ask questions.

I valued your detailed breakdown of my Mom's condition. While the news wasn't always uplifting I prefer the truth.

My Mom felt immediately comfortable with you . . . especially the way you explained things to her . . . often times in an analogy or your personal story.

We believe that a humanistic approach to medical education and residency training is better for doctors.  We also agree with Sinha that having such training and support for all would make us all better doctors.


nonlocal MD said...

I am told that the 'captain of the ship' mentality that formerly prevailed in commercial aviation stemmed from the military background of most of the pilots. Given that many of our most important advances in medicine were obtained from the military, I don't doubt that the training methods were too, especially given the same need for rapid decision-making in a setting of risk of loss of life.
Only, aviation has finally woken up to the inevitability of human error. The powers that be inside academic medical centers need to, also. Medicine is too complex for the old ways any longer.

Anonymous said...

I would also suggest that you utilize those patients who peruse legitimate medical research. People like that can help a lot, give them the chance and make use of what they have. Most of them are only looking to help.